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In Reply: Dr Blackwell objects to the results of the WHI randomized trials of estrogen with and without progestin, which showed an increase in urinary incontinence with treatment, because of methodological issues. He suggests that an important limitation of the study is a lack of data on gynecologic conditions (endometriosis, fibroids, and interstitial cystitis). We disagree. First, these conditions are uncommon in postmenopausal women. Second, in a randomized controlled trial as large as the WHI, study groups are generally comparable with respect to all variables (measured and unmeasured). As shown in the baseline characteristics table of our article,¹ chronic conditions were evenly distributed between treatment and control groups. This design enhances our ability to make inferences about the effect of the intervention on the outcome and is why the randomized trial remains the criterion standard for providing evidence on the effects of an intervention.

A second concern raised by Blackwell . . . [Full Text of this Article]

Susan L. Hendrix, DO
shendrix@med.wayne.edu
Department of Obstetrics and Gynecology
Wayne State University School of Medicine
Hutzel Women's Hospital
Detroit, Mich

Ingrid I. Nygaard, MD
Department of Obstetrics and Gynecology
Carver College of Medicine
University of Iowa
Iowa City

Barbara B. Cochrane, RN, PhD
Division of Public Health Sciences
Fred Hutchinson Cancer Research Center
Seattle, Wash

Vicki L. Handa, MD
Department of Obstetrics and Gynecology
Johns Hopkins University School of Medicine
Baltimore, Md

Vanessa M. Barnabei, MD, PhD
Department of Obstetrics and Gynecology
Medical College of Wisconsin
Milwaukee

Cheryl Iglesia, MD
Department of Obstetrics and Gynecology
Washington Hospital Center
Washington, DC

Aaron Aragaki, MS
Division of Public Health Sciences
Fred Hutchinson Cancer Research Center
Seattle, Wash

Michelle J. Naughton, PhD
Department of Public Health Sciences
Wake Forest University School of Medicine
Winston-Salem, NC

Robert B. Wallace, MD
Department of Epidemiology
University of Iowa College of Public Health
Iowa City

S. Gene McNeeley, MD
Department of Obstetrics and Gynecology
Wayne State University School of Medicine
Hutzel Women's Hospital
Detroit, Mich

for the WHI Investigators

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